My immediate goal is to acquire the additional didactic and mentored training in neuroimaging techniques, interpretation, and analyses and neuropsychological testing needed to establish myself as an independent clinical researcher. Funding from the K99/R00 award will provide me with additional didactic and mentored training in the management of longitudinal clinical trials, administration and interpretation of neuropsychological instruments, interpretation of structural and perfusion neuroimaging data sets, and biostatistical analyses. Key elements of this research career development plan include mentoring, formal coursework and completion of a pilot study. At the completion of this K99 award I will have the necessary knowledge, skills and experience to lead an interdisciplinary research team and complete the R00 portion of this award which will examine the relationships between brain magnetic resonance imaging (MRI) and cognitive impairment in older persons with heart failure (HF). Knowledge and experiences gained during this award will also allow me to move forward in the systematic examination of cognitive impairment in HF patients. My long term goal is to establish a career as an independent clinical investigator and build and lead an interdisciplinary research team in an academic setting. Environment: The rich resources and intellectual stimulation provided by the University of California, San Francisco (UCSF) as a whole, as well as the departments of Neurology and Radiology, and the School of Nursing, make this an outstanding environment to support the candidate's development into an independent clinical researcher. The candidate will participate in the K-Scholars program during the K99/R00 award period. This program consists of didactic training in the area of clinical research and is taught by nationally recognized clinical researchers. Other resources available to the candidate include 1) the School of Nursing, which is consistently ranked in the top 3 by U.S. News and World Report and National Institutes of Health funding; 2) the Institute for Health and Aging which was created to encourage interdisciplinary collaborative research and its faculty's research interests include chronic illness, health status and health promotion, and special populations (e.g. mild cognitive impairment, Alzheimer's and AIDS); 3) the Neuroimaging Center, which is a state of the art facility, that boasts high resolution structural and perfusion scanning technology; 4) the Memory and Aging Center, whose faculty have expertise in cognitive changes in normal aging as well as with a variety of neurodegenerative diseases and dementias. The institutional resources insure that the candidate will have the opportunity for daily interaction with distinguished clinical researchers from various disciplines. Research project: Cognitive impairment, commonly reported as difficulty with memory and executive function, is a widely recognized clinical challenge for older persons with HF. Little is known about the relationship between brain MRI and cognitive impairment in older persons with HF. A limited number of studies have investigated brain MRI in adults with HF and produced conflicting results. Previous findings are limited by use of lower resolution scanners (1.5 Tesla), lack of MRI techniques (i.e. combining structural sequences with perfusion sequences) and recruitment of mixed age samples. Based on these limitations, the purpose of this research plan is to explore the relationship between brain MRI and cognitive impairment in older persons with HF using high resolution structural and perfusion scans. To accomplish this goal, we will compare 75 adults with HF who are age > 65 years old with 75 healthy, gender, age, and education matched controls from an existing UCSF data set. We will obtain neuropsychological measures of multiple domains, as well as MRI measurements of the temporal lobe and prefrontal cortex at baseline and 12-months.